peds ch 2 normal dev
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Human development is orderly and predictable
there are individual differences and variations
age of walking vs age of talking
- which comes first
- adolscence-onset of menstratuation
orderly and predicable
prerequisites for development
if a child cannot sit independently, will he be able to walk?
bases for treatment
processes which are biologically programmed and yet can be changed via interaction with the environment
patterns of development
- control of movement develops head to toe
- gain control ofneck before trunk before extremities
- ex. sits before stands
- crawls before walks
- near to far
- gains control of trunk before extremities
- mass reactions-specific
ex. baby sees something he wants-pleasure is expressed by eye widening, wiggleing, arms waving (total body mov't)
older child see something he wants-he will smile and reach for the object
simple to complex
- ex.language development
- hand development
- gross raking grasp-palmar grasp-lateral pinch-pincer grasp
single sounds-blending sounds-words-sentences
gross motor to fine motor
child develops gross motor skills before fine motor skills
ex. moves arm-swats toy-pick upp large objects-picks up small objects
dBasic premisevelopmental approach
1. human beings normally develop in a sequential way
2. each new gain in structure (physical or mental) enables the individual to gain in function
3. each new gain in functional ability makes further development and adaptation possible
4. physical, sensosry, perceptual, cognitive, social and emotional aspects of the individual are intimately connected and affect the developmental state of the whole individual
5. conditions of stress cause the stressed individual to regress to earlier levels of adaptation
6. successful experiences foster a sense of wholeness and competence
therefore, a therapist must
provide success experiences by meeting the clients elvel of adaptation
encourage 'safe' exploration and practrice as the client enables to move to more mature levels of adaptation
provide opportunities for challenge, surprise and novelty when the client is ready
1. a normal baby doesnot develop head control in prone-head control develop ina vertical plane while being held
2. head control develops as a result of a balance between flexors and extensors
3. vertical, horizontal, and diagonal control can develop in any sequence
4. vertical control is not complete before horizontal control begins to develop. Development of vertical, horizontal and diagonal control overlaps.
5. once midlein control develops-then control of the sides develops and then dissociation of one side from the other
1. symmetrical control
- both sies do the same thing
- mirror motor act(opposite)
each side does someething different
need the rotational component to gain control
3. dissociation of movement
- upper extremitiesfrom lower extremities (top from bottom)
- pull to stand
- flexion of upper extremeities
- extension lower extremities
development of movement
- 1. the infant starts by moving and then sensory input modifies the movement
- ex. wear nightgown to bed and is just doesn't feel right, get up and change
are present to provide more movement
gives the baby control and movement when he doesn't have it.
4. muscle tone
- 3. mass patterns of movements to more isolated movements to refined movements
(resting tesnions of the muscle) develops from the feet to the head
5. muscle control
develops from the head to the feet
and proximal (center) to distal (outward/extremities) after birth
6. infants start out in physiological flexion
- 1st movement is extension
- shortly after birth,controlled flexion begins
- flexion/extension of neck is initially asymmetrical
- flexion/extension of neck become symmetrical with midline orientation
extension control develops faster than flexion control
flexion/extension working on opposite sides of the body=rotation with the body axis
development of movement(continued)
7. different interaction of muscle groups creates different movements
8. as trunk gains control,the same flexion/extension control needs to develop in the extremities
front/back rocking on extended arms and knees=flexion/extension
weight bearing-side to side shift-abduction/adduction
develops with wt. bearing and reaching
development of movement(continued)
9. perception also develops in the same patterns
perception develops with motor control
10. control occurs first in wt. bearing positions before in space
needs to have control in prone on elbows or extended arms before reaching
needs to have control in sitting before freeing arms for play
spinal level-phasic rel=flexes-birht -2month
brainstem-tonic reflexes-birth-4/6 months
midbrain level-righting reactions-through life
cortical level-equilibrium reactions-through life
what is a reflex?
a specific automatic patterned response elicited by aparticular stimulus.
it does not involve any conscious control.
it produces a change in muscle tone and its distribution.
a motor output...
that follows some specific sensory input.
it is performed automatically and without conscious control
are part of normal development
provide the control for a newborn'smovement.
- lower center of the brain generate reflexes movements and postures. Cortex-highest level
- brainstem-spinal level
reflexes help the child to develop:
normal muscle tone
movement of an increasingly refined and coordinated nature
Reflexes regulate the
degree, strength, balance, and distribution of muscle tone necessary for posture andmovement.
Reflexes are grouped:
- Phasic reflex
- observable movement in response to a touch, pressure, or movement of the body or to a sight or sound received.
They coordinate the muscles of the extremities in patterns of either total flexion or extension
- ex. touching a hot stove
- trying to put their one's on and they keep pulling their leg out
Static postural reflexes that effect changes in the distribution of muscle tone throughout the body, either in response to a change in the head and body in space or in the head in relation to the body.
- Righting reactions
- interact with each other and work toward the establishment of normal head and body relationship in space as well as in relation to each other.
they occur when muscle tone is normalized and provide body adaptation in response to a change in the center of gravity in the body.
reflexes that appear during gestation or at birth and become integrated by 4-6months.
they are not considered pathological or abnormal because they are present in all normal full-term newborns
spinal level/brainstem level
reflexes that appear in infancy or childhood and remain throughtout life
integration of reflexes
reflexes do not disappear butmay serve as building blocks for more complex reactions.
they are covered up
by voluntary motor control.
the reflexes may reappear under stressful conditions or as a result of damage to the brain or spinal cord.
- higher motor skills are developed.
- no longer need the reflex
the posture or movement produced when a person is dominated by a reflex
this response is consistent and predictable and unable to be changed.
a reflex is also considered obligatory if it persists after the age at which the reflex should have been integrated
no controlled movement
ex. CP-move head and there is no other response/reflex action
see reflex in older person
they had normal motor skills and now see reflexes that are part of normal development are due to a pathological reason
there was an injury, illness, stroke
in adult, not referred to as a primitive reflex. he had normal reflex skills and now becuz of an illness he doesn't
position in which the infant or child should be placed prior to the elicitation of the reflex or reaction
the action of the examiner which should cause the response
apply whatever stimulus that i'm suppose to do
ex. touch-apply touch
the action of the infant or child in response to the stimulus
what the person does (after elicit)
reason the reflex or reaction is important to normal motor development
- related to normal development
- Why is it related to normal development? dones it development strength, stability, movement,
age of the infant or child when the reflex or reaction is normally developed
when reflex starts to be present
ex. birth-4 months. birth
age of the indivudual at which the relfex or reaction normally becomes rreplaced by voluntary motor control
ex. birth to 2 months. 2 months, the end range
reflex present, but not necessarily good
if reflex is present and beyond point of integration, then that is abnormal
normal: when the reflex in within the onset/integration timeline
the reflex is absent
normal depends if reflex is absent within the onset/integration stage
if reflex persists:
consequences to normal motor development and
if reflex persists
consequences to normal motor development and/or possible pathological indications if a reflex or reaction persists longer than normal or if the response is obligatory
when reflex is still present past the timeline that it is suppose to be
if reflex is absent
consequences to normal motor development and/or possible pathologoical indications if a reflex or reaction is absent or weakened
could be good or bad
when you want reflexes to be absent
level of integration
level of central nrevous system at which the reflex or reaction is integrated
- the 4 levels used are:
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